Exploring Self-care Among Low Socioeconomic Status Heart Failure Patients: A Mixed Methods Study

Heart failure costs the US healthcare system $20.9 billion annually and is a serious public health burden to society. Eighty percent of heart failure (HF) costs are related to hospitalizations and unplanned hospital readmissions (UHR). Self-care has been identified as a foundation of heart failure management and poor self-care has been identified as one reason for UHR’s. Other factors influencing UHR’s are socioeconomic status (SES). In recent years, researchers have examined the impact self-care has upon UHRs in patients with heart failure. However, the factors influencing self-care among low SES patients with HF experiencing a UHR has not been examined. A mixed methods study utilizing an embedded concurrent design was used to understand how family dynamics and individual factors influence self care among a low SES patients who have HF. Qualitative data and quantitative data were collected from subjects (n=35) during an inpatient stay at two publicly funded hospitals in Chicago. The data was gathered using a semi-structured interview, a blood test measuring alcohol use, a demographic survey and survey tools measuring self-care, perceived stress, and alcohol use. There are several novel findings from this study: 1) The majority of subjects performed inadequate self-care, 2) For many subjects, negative family dynamics and life circumstances (i.e. multiple family deaths) were related to inadequate HF self-care management and increased UHRs, 3) Subjects who experienced multiple poor interactions with healthcare systems, live in high crime geographic areas and experience fragmented care (i.e. visit multiple hospitals), demonstrated a high level of apathy and low motivation to engage with the health care system and pro-actively manage their HF, and 4) Subjects with the highest number of UHRs are more likely to have a history of addiction or be current substance abusers. The results of this study identify some of the unique challenges experienced by HF patients with low SES. Life circumstances and individual factors play a critical role in HF self-care and UHR’s. Further research is needed to develop strategies to identify these factors and develop interventions to support self-care among this patient population.